Prioritize Contact Lens Comfort
By Sathi Maiti, OD
Dropout is over 20% for contact lens wearers and over 25% for first-time wearers, and discomfort is a top reason.1 These patients are dissatisfied with their contact lenses and sometimes, by extension, with their eye care practitioner. After all, the lens we told them would be their best option has not worked out for them.
In my experience, even among patients who stay in their contact lenses, satisfaction with comfort can be low. It’s not uncommon to get new patients who say they’ve been wearing contacts for years, but only for a few hours at work until they get too uncomfortable. No doubt, that’s not what they envisioned when they decided to get contacts.
To keep patients happy, prevent dropout and grow our practices, we need to ensure that patients feel comfortable in their lenses for at least most of the day. With so many lenses to choose from, that’s easier than ever.
Setting (and Often Raising) Expectations
When we talk about patient satisfaction, we often think about perfectionists because they can be so hard to please. When it comes to contact lenses, I also see another common and very different challenge to patient satisfaction: low expectations.
I am often surprised by how much discomfort patients will tolerate without complaint. I ask returning patients, “How are you doing with your contacts?” and they say, “Fine.” When I ask, “How do your lenses feel on a scale of 1 to 10— 1 being just awful and 10 being you don’t even know your contacts are there?” The same person will answer with a 6 or 7. “Do you get through the whole workday in your lenses?” “No—just a few hours.”
Many people just accept this low level of comfort and performance from their contact lenses. They think that’s normal for contacts, so they put up with it. They think if they complain, we will take away the option of contact lenses from them and tell them they can only wear glasses. We need to change their expectations.
I tell my young, healthy patients who spend plenty of time staring at screens that my goal for them is 8-10+ hours per day of comfort in their contact lenses—at least a full workday, if not more. If the patient has dry eye disease or other problems, we can treat those concurrently and adjust expectations, but no one should be limping along with a few hours of comfortable wear time. I explain to all my patients that if they’re really uncomfortable or they’re only getting a few hours of comfortable wear per day, I want them to contact me. We can try other options to make sure they are more comfortable.
Getting Comfortable: Right Lens, Right Fit
For comfort, highly oxygen-permeable silicone hydrogel daily disposables have been a game-changer. The industry is shifting toward daily disposables because they’re more comfortable, hygienic, and convenient for patients. We have fewer worries about patients’ compliance with recommendations for replacement or cleaning because patients get a fresh, new, sterile lens every day.
I typically start new contact lens patients with silicone hydrogel daily disposables, and I often switch patients who are wearing hydrogel lenses and having comfort issues. My 2 go-to daily disposable lenses are the Acuvue Oasys 1-Day lens (Johnson & Johnson Vision) and Dailies Total 1 (Alcon). For patients with astigmatism, I like the Acuvue Oasys 1-Day for Astigmatism, which has a wide range of prescriptions to expand the number of patients who can wear daily disposables. A new 1-day lens called Acuvue Oasys Multifocal with Pupil Optimized Design is now available as well, and I’m looking forward to trialing it with my patients. If silicon hydrogel daily disposables don’t work for a patient, we have many other materials and designs from which to choose.
As part of the fitting process, I always have patients test out new lenses for 1 or 2 weeks, so they can see how the lenses feel in their regular activities. I want them to assess how comfortable they feel over the course of the day. We can try another option or adjust the prescription if needed. It’s well worth it to know that my patients will be comfortable before they buy boxes of lenses.
A Satisfied Practice
When I take proactive steps to ask patients about comfort and explain that I don’t want them to be bothered by their contacts, I think it shows them that I care. They seem to trust me with their other eye problems, and they are more likely to recommend me to their friends and family and write positive reviews online that boost my practice’s reputation. Word of mouth is still the way that we tend to get new patients, so a positive patient experience really does drive practice growth.
Retaining contact lens wearers is so important because they come in for exams more often. They need to replenish their supply of lenses, so they come in for a visit, whereas eyeglass wearers tend to wait longer. A happy contact lens patient brings in more revenue long-term than a happy “just eyeglasses” patient, so in terms of practice growth, it’s important to retain those patients. Comfortable contact lenses go a long way in achieving that goal.
Pucker AD, Tichenor AA. A Review of Contact Lens Dropout. Clin Optom (Auckl). 2020;12:85–94.
Sathi Maiti, OD, is an ocular surface disease fellow at the Periman Eye Institute and a primary care optometrist in Seattle.